From the Guidelines
Patients receiving secukinumab for psoriasis should discontinue the medication at least 4 half-lives prior to carpal tunnel surgery, which is approximately 12-16 weeks (3-4 months) for secukinumab, considering its half-life is around 22-31 days 1. The recommendation to discontinue secukinumab 4 half-lives before surgery is based on guidelines for biologic interventions in psoriasis, which suggest applying similar discontinuation rules as for TNF antagonists in RA, due to the lack of specific evidence for secukinumab 1.
- Key considerations for the timing of secukinumab discontinuation include:
- The half-life of secukinumab, which is around 22-31 days, implying a longer discontinuation period compared to some other biologics.
- The balance between the risk of surgical infection and the potential for psoriasis flare upon discontinuation of secukinumab.
- Individual patient factors, such as the severity of psoriasis, infection risk factors, and the complexity of the surgical procedure. After surgery, secukinumab can usually be resumed once the surgical wound has healed adequately, but this should be confirmed with the surgeon, typically after 1-2 weeks post-operation, to minimize the risk of infection while also considering the risk of psoriasis flare 1.
- It is crucial for patients to discuss the timing of secukinumab discontinuation and resumption with both their dermatologist and surgeon to create a coordinated plan that balances the risks and benefits in the context of their specific situation.
From the Research
Secukinumab and Surgery
- There are no research papers to assist in answering this question regarding how long a patient receiving secukinumab for psoriasis should stop this drug prior to carpal tunnel surgery 2, 3, 4, 5, 6.
Considerations for Secukinumab Treatment
- Secukinumab is a fully human monoclonal antibody that selectively neutralizes interleukin-17A and shows long-lasting efficacy and safety in plaque psoriasis 3.
- The optimal dosing regimen for secukinumab is 300 mg every 4 weeks, which achieves and maintains clear or almost clear skin in the majority of patients 4.
- Patients with a higher body weight (≥ 90 kg) not achieving PASI 90 response at week 24 may benefit from a dosing regimen of 300 mg every 2 weeks 4.
- Secukinumab can be effective in combination with concomitant methotrexate administration in patients with moderate-to-severe psoriasis 6.
Real-World Effectiveness and Safety
- The PROSPECT study provides a large prospective real-world analysis of secukinumab treatment, including prior and concomitant use of psoriasis treatments, and shows that secukinumab effectiveness and safety are comparable to those seen in clinical trials 5.